Lecture 9.1 - Neurological System Flashcards
After what age is there a steady loss of neurons?
After 65 years
What does the neural atrophy caused by aging do to the rest of the body?
–> Loss of muscle strength and bulk
–> Loss of tone around face/neck/spine
–> Impaired fine motor coordination
–> Decreased reaction time
–> Loss of senses (Touch, pain, taste, and smell)
–> Loss of sense of vibration in ankle, absence of Achilles reflec
Why are older adults predisposed to falls?
Loss of muscle strength and tone, as well is dizziness and loss of balance contributes to more incidence of falling
–> Loss of short term memory also results in forgetfulness about injuries
What might lead to an epilepsy diagnosis?
More than two seizures in 24 hours
What is dysmetria?
Loss of coordination
What is senile tremor?
A slight tremor or shake that is normal in many elderly individuals.
How is Cranial Nerve 1 tested? Is this a part of routine practice?
Check patients sense of smell
–> Check only if you suspect issue
How is cranial nerve II tested?
With the Snellen Chart and a peripheral vision field test.
how is are cranial nerves III, IV, and VI tested?
Test 6 cardinal fields of gaze, check convergence and accommodation.
Inspect pupil size, shape, equality, and light reflex.
Inspect palpebral fissures.
How is cranial nerve V tested for?
Palpate mastication of muscles while clenching teeth
Check sensation on forehead, cheeks, and chin
Corneal test only if you suspect issue.
How should a corneal test be conducted?
With an eyedrop.
–> Used to be checked with a tissue or gauze, but this cause microscopic lesions on the cornea and it cannot be donated.
How is cranial nerve VII tested?
Examine mobility of face while making facial expressions
Check taste only if you suspect issue
How id cranial nerve VIII tested?
Whispered voice test and Romberg test
What is the Whispered Voice Test?
Whispered a sequence of letters/numbers at about arms length from patient.
How are Cranial Nerves XI and X tested?
Examine pharyngeal movement when saying ‘aaaah’
Smoothness of voice when talking
Gag reflex - done only of necessary
Taste - done only if necessary
+ Check ROM and strength of trapezius and sternomastoid
How is cranial nerve XI tested?
Test ROM and strength of trapezius and sternomastoid
How is cranial nerve XII tested?
Examine tongue tone, bulk, and movement
Listen for clarity of speech
What is tandem gait?
Walking heel to toe, as if on a tightrope
What is the one leg hop? When should a shallow knee bend be used instead?
Used to assess balance.
Use shallow knee bend on elderly individuals to prevent falls/injury
What is the Romberg test?
A test used to determine balance.
Ask patient to stand upright with eyes closed for 20 seconds.
Some swaying is normal, but patient should not fall over.
Which coordination tests should be performed on someone during a motor assessment?
- Rapid alternating movements
—> Flip hands quickly on legs - Finger to nose test
–> (eyes closed) - Finger-to-finger
–>E.T - Heel-to-shin
–> Can be done laying or sitting
How can the spinothalamic tract be tested?
–> Pain
–> Temperature (only if necessary)
–> Light touch
How can the posterior column tract be tested?
–> Vibration
–> Position
–> Tactile Discrimination
How can we test for perception of pain?
Sharp or dull test
How can we test for light touch perception?
With a wisp of cotton or tissue
How do we test for perception of vibration?
Hold tuning fork over bony prominences and ask pt to tell you when it starts and stops
How can we test for kinesthesia?
Move pt’s finger up and down (hold sides) with their eyes closed. Ask them to tell you if it has moved up or down.
What is stereognosis?
The ability to identify objects by touch
What is graphaesthesia?
The ability to read a number traced on the skin
What is extinction in the context of tactile discrimination?
The inability to perceive multiple stimuli of the same type simultaneously.
What is point location?
The ability to point to a spot where touch was felt
How are deep tendon reflexes graded?
0 - no response
1+ - Diminished, low normal
2+ - Normal, average
3+ - Brisker than average, may indicate disease
4+ - Very brisk, hyperactive with clonus. Indicative of disease
How are the bicep reflexes tested?
Support forearm and hold thumb on bicep tendon.
Strike thumb, observe forearm flexion.
How are triceps reflexes tested?
Suspend upper arm and strike triceps tendon directly. Observe forearm extension.
How is the Brachioradialis tendon reflex observed?
Suspend forearm by holding pt’s thumbs. Strike forearm directly, 2-3 cm above radial styloid process. Observe flexion and supination of forearm.
How do you elicit the patellar/quadricep reflex?
Allow lower leg to dangle and strike tendon directly, just below patella. Observe extension of lower leg.
How do you elecit the Achilles reflex?
Knee should be flexed and externally rotated, hold foot in dorsiflexion. Strike Achilles tendon directly, observe plantar flexion.
How is abdominal reflex elicited?
Lie patent supine with knees bent. Stroke skin with reflex hammer from lateral abdomen to midline. Observe ipsilateral contraction of abdominal muscles and deviation of umbilicus toward stroke.
How is the plantar reflex elicited?
Patient should lie in slight external rotation. Stroke the lateral side of the sole of foot in upside down J formation. Observe plantar flexion.
Which cranial nerves become reduced in older adults?
VII, IX, X and I
(taste and smell)
Which reflexes are lost in older adults?
Loss of Achilles reflex, all deep tendon reflexes are less brisk.
Absent plantar & superficial abdominal reflexes
What is Dyskinesia?
Involuntary erratic movements
–> Shakes, tics, and tremors.
What is muscle flaccidity? What kind of injury/condition is it associated with?
Decreased Muscle tone, weakness and fatigue - associated with lower neuron injury
What is muscle spasticity? What kind of injury/condition is it associated with?
Increased muscle tone and resistance to passive strengthening. - associated with upper neuron injury
What is muscle Rigidity? What kind of injury/condition is it associated with?
A constant state of resistance - associated with injury to extrapyramidal motor tracts (such as basal ganglia)
What is cogwheel rigidity? What kind of injury/condition is it associated with?
A type of rigidity in which increased tone lessens by degrees during passive ROM, feels like small, regular jerks - associated with Parkinsonism.
What is Multiple Sclerosis? What are its symptoms?
MS is a chronic, progressive, autoimmune disease where axons become inflamed, demyelinated, degenerated, and undergo sclerosis.
Symptoms include blurred vision, diplopia, extreme fatigue, weakness, spasticity, numbness, tingling, loss of balance.
What is paraplegia?
Lower motor neuron damage due to spinal cord injury
What are the stages of paraplegia?
Initial spinal shock - no movement or reflexes below lesion
Gradual return of deep tendon reflexes –> Flexor spasm –> Extensor Spasm –> Extensor tone
